Obsessive-Compulsive Personality Disorder
DSM-II In DSM-II, this disorder is called Obsessive compulsive personality This behavior pattern is characterized by excessive concern with conformity and adherence to standards of conscience. Consequently, individuals in this group may be rigid, over-inhibited, over-conscientious, over-dutiful, and unable to relax easily. This disorder may lead to an Obsessive compulsive neurosis, from which it must be distinguished. DSM-III In DSM-III, this disorder is called Compulsive Personality Disorder Diagnostic Criteria At least four of the following are characteristic of the individual's current and long-term functioning, are not limited to episodes of illness, and cause either significant impairment in social or occupational functioning or subjective distress. # restricted ability to express warm and tender emotions, e.g., the individual is unduly conventional, serious and formal, and stingy # perfectionism that interferes with the ability to grasp "the big picture," e.g., preoccupation with trivial details, rules, order, organization, schedules, and lists # insistence that others submit to his or her way of doing things, and lack of awareness of the feelings elicited by this behavior, e.g., a husband stubbornly insists his wife complete errands for him regardless of her plans # excessive devotion to work and productivity to the exclusion of pleasure and the value of interpersonal relationships # indecisiveness: decision-making is either avoided, postponed, or protracted, perhaps because of an inordinate fear of making a mistake, e.g., the individual cannot get assignments done on time because of ruminating about priorities Differential Diagnosis Obsessive Compulsive Disorder In Obsessive Compulsive Disorder there are, by definition, true obsessions and compulsions, which are not present in Compulsive Personality Disorder. However, if the criteria for both disorders are met, both diagnoes should be recorded. DSM-IV Diagnostic Criteria A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: # is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost # shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) # is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessary) # is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) # is unable to discard worn-out or worthless objects even when they have no sentimental value # is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things # adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes # shows rigidity and stubbornness Differential Diagnosis Obsessive-Compulsive Disorder Despite the similarity in names, Obsessive-Compulsive Disorder is usually easily distinguished from Obsessive-Compulsive Personality disorder by the presence of true obsessions and compulsions. A diagnosis of Obsessive-Compulsive Disorder should be considered especially when hoarding is extreme (e.g., accumulated stacks of worthless objects present a fire hazard and make it difficult for others to walk through the house). When criteria for both disorders are met, both diagnoses should be recorded. Other Personality Disorders Other Personality Disorders may be confused with Obsessive-Compulsive Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Obsessive-Compulsive Personality Disorder, all can be diagnosed. Narcissistic and Antisocial Personality Disorders Individuals with Narcissistic Personality Disorder may also profess a commitment to perfectionism and believe that others cannot do things as well, but these individuals are more likely to believe that they have achieved perfection, whereas those with Obsessive-Compulsive Personality Disorder are usually self-critical. Individuals with Narcissistic or Antisocial Personality Disorder lack generosity but will indulge themselves, whereas those with Obsessive-Compulsive Personality Disorder adopt a miserly spending style toward both self and others. Schizoid Personality Disorder Both Schizoid Personality Disorder and Obsessive-Compulsive Personality Disorder may be characterized by an apparent formality and social detachment. In Obsessive-Compulsive Personality Disorder, this stems from discomfort with emotions and excessive devotion to work, whereas in Schizoid Personality Disorder there is a fundamental lack of capacity for intimacy. Personality Change Due to a General Medical Condition and symptoms related to substance use Obsessive-Compulsive Personality Disorder must be distinguished from Personality Change Due to a General Medical Condition, in which the traits emerge due to the direct effects of a general medical condition on the central nervous system. It must also be distinguished from symptoms that may develop in association with chronic substance use (e.g., Cocaine-Related Disorder Not Otherwise Specified). Normal personality traits Obsessive-compulsive personality traits in moderation may be especially adaptive, particularly in situations that reward high performance. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute Obsessive-Compulsive Personality Disorder. DSM-5 Diagnostic Criteria A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: # Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. # Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because of his or her own overly strict standards are not met). # Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). # Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious indentification). # Is unable to discard worn-out or worthless objects even when they have no sentimental value. # Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. # Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. # Shows rigidity and stubbornness. Alternative Model Proposed Diagnostic Criteria A'''. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: # ''Identity'': Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions. # ''Self-direction'': Difficulty completing task and realizing goals, associated with rigid and unreasonably high and inflexible internal standards of behavior; overly conscientious and moralistic attitudes. # ''Empathy'': Difficulty understanding and appreciating the ideas, feelings, or behaviors of others. # ''Intimacy'': Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others. '''B. Three or more of the following four pathological personality traits, one of which must be (1) Rigid perfectionism: # Rigid perfectionism (an aspect of extreme Conscientiousness opposite pole of Detachment): Rigid insistence on everything being flawless, perfect, and without errors or faults, including one's own and others' performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order. # Perseveration (an aspect of Negative Affectivity): Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures. # Intimacy avoidance (an aspect of Detachment): Avoidance of close or romantic relationships, interpersonal attachments, and intimate sexual relationships. # Restricted affectivity (an aspect of Detachment): Little reaction to emotionally arousing situations; constructed emotional experience and expression; indifference or coldness. C'''. The impairments in personality functioning and the individual's personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations. '''D. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood. E'''. The impairments in personality functioning and the individual's personality trait expression are not better explained by another mental disorder. '''F. The impairments in personality functioning and the individual's personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (e.g., severe head trauma). G'''. The impairments in personality functioning and the individual's personality trait expression are not better understood as normal for an individual's developmental stage or sociocultural environment. '''Specifiers Trait and personality functioning specifiers may be used to record additional personality features that may be present in obsessive-compulsive personality disorder but are not required for the diagnosis. For example, other traits of Negative Affectivity (e.g., anxiousness) are not diagnostic criteria for obsessive-compulsive personality disorder (see Criterion B) but can be specified when appropriate. Furthermore, although moderate or greater impairment in personality functioning is required for the diagnosis of obsessive-compulsive personality disorder (Criterion A), the level of personality functioning can also be specified. Differential Diagnosis Obsessive-compulsive disorder Despite the similarity in names, OCD is usually easily distinguished from obsessive-compulsive personality disorder by the presence of true obsessions and compulsions in OCD. When criteria for both obsessive-compulsive personality disorder and OCD are met, both diagnoses should be recorded. Hoarding disorder A diagnosis of hoarding disorder should be considered especially when hoarding is extreme (e.g., accumulated stacks of worthless objects present a fire hazard and make it difficult for others to walk through the house). When criteria for both obsessive-compulsive personality disorder and hoarding disorder are met, both diagnoses should be recorded. Other personality disorders Other personality disorders may be confused with obsessive-compulsive personality disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to obsessive-compulsive personality disorder, all can be diagnosed. Narcissistic and antisocial personality disorder Individuals with narcissistic personality disorder may also profess a commitment to perfectionism and believe that others cannot do things as well, but these individuals are more likely to believe that they have achieved perfection, whereas those with obsessive-compulsive personality disorder are usually self-critical. Individuals with narcissistic or antisocial personality disorder lack generosity but will indulge themselves, whereas those with obsessive-compulsive personality disorder adopt a miserly spending style toward both self and others. Schizoid personality disorder Both schizoid personality disorder and obsessive-compulsive personality disorder may be characterized by an apparent formality and social detachment. In obsessive-compulsive personality disorder, this stems from discomfort with emotions and excessive devotion to work, whereas in schizoid personality disorder there is a fundamental lack of capacity for intimacy. Other personality traits Obsessive-compulsive personality traits in moderation may be especially adaptive, particularly in situations that reward high performance. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute obsessive-compulsive personality disorder. Personality change due to another medical condition Obsessive-compulsive personality disorder must be distinguished from personality change due to another medical condition, in which the traits emerge attributable to the effects of another medical condition on the central nervous system. Substance use disorders Obsessive-compulsive personality disorder must also be distinguished from symptoms that may develop in association with persistent substance use.